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Millennial patients know less about their health benefits, are less likely to pay their medical bills in full and often don’t save for medical expenses, according to a survey published by TransUnion Healthcare.

St. Louis-based Ascension Health and Renton, Washington-based Providence St. Joseph Health are discussing a merger, according to the Wall Street Journal, which would create a massive nonprofit health system of 191 hospitals in 27 states.

More than a year after first announcing they were negotiating a merger, Dignity Health and Catholic Health Initiatives (CHI) have a definitive agreement to create a massive nonprofit health system based out of Chicago with more than $28 billion in combined revenue.

Optum, the consulting and services arm of health insurance giant UnitedHealth Group, has continued a series of major acquisitions with the announcement it will buy DaVita Medical Group, a division of kidney dialysis firm DaVita, for $4.9 billion.

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The University of Pittsburgh Medical Center (UPMC) saw its credit rating downgraded by Moody’s Investor Service, along with maintaining a negative outlook on the system, citing its “accelerated expansion and high execution risk” with the acquisition of the seven-hospital PinnacleHealth System.

Tenet Healthcare announced it will sell eight hospitals in the U.S. and its nine hospitals and clinics in the United Kingdom, yielding up to $1 billion for the company, though breaking up the company’s three main business lines is also a possibility, according to outgoing CEO Trevor Fetter.

St. Joseph Medical Center in Tacoma, Washington, has been sued by the state’s attorney general for allegedly instructing employees not to mention the availability of charity care to patients, even when they were “obviously low-income or homeless.”

In markets where both insurers and providers have become highly concentrated, insurers had enough bargaining power to reduce prices on hospitalization and certain specialty care. Those savings were not, however, passed onto consumers in the form of lower premiums.

Charlotte-based Carolinas HealthCare System, already the largest health system in North Carolina, has announced plans to grow even bigger by creating a joint venture with University of North Carolina (UNC) Health Care.

The American Hospital Association (AHA) and dozens of doctors and hospitals have asked CMS to delay proposed cuts to Medicaid disproportionate share hospital (DSH) payments, arguing reductions would hamper safety-net hospitals and criticizing how the payments would be calculated.